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Review
. 2024 Jan 5;12(1):E23-E33.
doi: 10.1055/a-2204-8316. eCollection 2024 Jan.

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

Matheus de Oliveira Veras  1 , Diogo Turiani Hourneaux de Moura  1 , Thomas R McCarty  2 , Guilherme Henrique Peixoto de Oliveira  1 , Rômulo Sérgio Araújo Gomes  1 , Davi Lucena Landim  1 , Felipe Giacobo Nunes  1 , Tomazo Antônio Prince Franzini  1 , Marcos Eduardo Lera Dos Santos  1 , Wanderley Marques Bernardo  3 , Eduardo Guimarães Hourneaux de Moura  1
Affiliations
Review

Intraductal radiofrequency ablation plus biliary stent versus stent alone for malignant biliary obstruction: a systematic review and meta-analysis

Matheus de Oliveira Veras et al. Endosc Int Open. .

Erratum in

Abstract

Background and study aims Recurrent biliary stent occlusion and tumor ingrowth remain a major concern among patients with malignant biliary obstruction (MBO) with significant impact on patient morbidity and survival. Intraductal radiofrequency ablation (RFA) has emerged as a promising treatment that seeks to extend stent patency. This study aimed to evaluate the impact of RFA on overall survival (OS) and stent patency among patients with unresectable MBO. Methods A comprehensive search of electronic databases was performed for randomized controlled trials (RCTs) comparing RFA plus biliary stent (RFA+S) versus biliary stent alone (S-alone). Outcomes assessed included overall survival, stent patency, and adverse events (AEs) with mean difference (MD) calculated from pooled proportions. Subgroup analyses were performed for hilar strictures and cholangiocarcinoma (CCA). Results Six RCTs (n=439 patients) were included and demonstrated improved survival among patients who received RFA+S (MD 85.80 days; 95% confidence interval [CI] 35.02-136.58; I 2 =97%; P <0.0009). The pooled MD for total stent patency was 22.25 days (95% CI 17.38-61.87; I 2 =97%; P =0.27). There was no difference in AEs between RFA+S vs S-alone ( P >0.05). On subgroup analyses, RFA+S was associated with improved stent patency (MD 76.73 days; 95% CI 50.11-103.34; I 2 =67%; P <0.01) and OS (MD 83.14 (95% CI 29.52-136.77; I 2 =97%; P <0.01] for CCA. For hilar strictures, stent patency was improved among patients with RFA+S [MD 83.71 days (95% CI 24.85-142.56; I 2 =84%; P <0.01]. Conclusions RFA+S improved OS in the treatment of MBO when compared with S-alone. Moreover, the RFA therapy prolonged stent patency in hilar strictures and CCA, with similar rates of AEs.

Keywords: PTCD/PTCS; Strictures.

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Conflict of interest statement

Conflict of Interest Dr. Diogo Turiani Hourneaux De Moura: BariaTek Medical - Advisory Board Member (Consulting fees). This was not relevant to this study. Dr. Eduardo Guimaraes Hourneaux De Moura: Olympus - Consultant (Consulting fees) and Boston Scientific - Consultant (Consulting fees). These were not relevant to this study. The other authors declare no potential conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram showing study selection process for meta-analysis.
Fig. 2
Fig. 2
Risk-of-bias assessment.
Fig. 3
Fig. 3
Forest plots: RFA+S vs S-alone – overall survival.
Fig. 4
Fig. 4
Forest plots: RFA+S vs S-alone – 3- and 6-month survival rates.
Fig. 5
Fig. 5
Forest plots: RFA+S vs S-alone – overall survival in patients with CCA.
Fig. 6
Fig. 6
Forest plots: RFA+S vs S-alone – total stent patency.
Fig. 7
Fig. 7
Forest plots: RFA + S vs S-alone – 3- and 6-month stent patency rates.
Fig. 8
Fig. 8
Forest plots: RFA+S vs S-alone – stent patency concerning type of stent.
Fig. 9
Fig. 9
Forest plots: RFA+S vs S-alone – stent patency in patients with CCA.
Fig. 10
Fig. 10
Forest plots: RFA+S vs S-alone – 3- and 6-month stent patency rate in CCA.
Fig. 11
Fig. 11
Forest plots: RFA+S vs S-alone – stent patency in patients in hilar strictures.
Fig. 12
Fig. 12
Forest plots: RFA+S vs S-alone – 3- and 6-month stent patency rates in hilar strictures.
Fig. 13
Fig. 13
Forest plots: RFA + S vs S-alone – total procedure-related AEs in the initial 30 days.
Fig. 14
Fig. 14
Forest plots: RFA + S vs S-alone – detailed analysis of AEs.
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